ENTRY FORM - A Coventry Way Challenge 15th April 2012

(Relay captains please fill in)

Please be aware of opening/closing times of 7 checkpoints
Kenilworth (7.9miles):	07:00 to 11:30		Bedworth (30.6miles):	12:30 to 18:00					- Registration from 05:00 - Start times are flexible. - Any individual may start at   any time  up until 10:00. BUT ... Please note opening and closing times of checkpoints on left.
Bubbenhall (14.0miles):	08:30 to 13:00		Breach Oak La. (34.2miles):	13:00 to 18:30
Wolston (18.0miles):	09:30 to 14:00		Corley Moor (37.1miles):	13:30 to 20:00
Brinklow (22.4miles):	10:30 to 15:30
Finish closes at 21:00

Food and drink will be available at the checkpoints.  Please bring your own drinking mug.
A meal will be provided at the Finish for all participants and helpers.

 Please enter me for 'A Coventry Way Challenge 2012'   
( Entry limited to 250.  No entries on the day )
  

• I confirm that I am in good health and have no medical condition that may cause concern/inconvenience to others.
• I agree to abide by the Rules of the Event and understand that no liability is accepted by the organisers for any injury, damage or loss sustained by me in connection with it.
• I agree to observe The Country Code.  
• I enclose a cheque/PO (payable to 'ACWA') -  £12 Individuals - £24 Relay Teams. 
  36 page "Map & Route Description Booklet" plus final details will be sent by mid-March.

Signed  ..........................................................................................................	Date ....................................
Signature of Parent/Guardian/Adult (under 18s) ...................................................................................

Relay Name (BLOCK CAPITALS)